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Ashby M. One Last Unexpected Lesson From the Life and Death of Queen Elizabeth II? JOURNAL OF BIOETHICAL INQUIRY 2022; 19:521-525. [PMID: 36729347 PMCID: PMC9893188 DOI: 10.1007/s11673-022-10225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Michael Ashby
- Sub Acute, Aged & Community Services, Royal Hobart Hospital, Tasmanian Health Service, and School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia.
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Scott Z, O'Curry S, Mastroyannopoulou K. The impact and experience of debriefing for clinical staff following traumatic events in clinical settings: A systematic review. J Trauma Stress 2022; 35:278-287. [PMID: 34672028 DOI: 10.1002/jts.22736] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/08/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022]
Abstract
Health care professionals are more frequently exposed to potentially traumatic events than individuals in other professions. Repeated trauma exposure can significantly impact both physical and mental health. In clinical settings, the term "debriefing" refers to a group meeting during which clinical events and decision-making are reviewed and discussed to improve clinical practice. The present review investigated the use of debriefing for clinical staff in clinical settings following exposure to direct and vicarious trauma. We examined whether the use of posttrauma debriefing impacts symptoms of distress and explored how clinical staff experience debriefing; we also investigated the factors that influence this experience. A systematic search of five electronic databases was conducted between August 31 and September 2, 2019. Included articles (N = 13) described the use of debriefing in clinical settings with clinical staff following a traumatic event. We assessed methodological quality and performed a narrative synthesis. Four studies found some evidence of the benefits of debriefing for reducing psychological sequelae to traumatic events. Seven studies commented on factors that clinical staff perceived to be important for the debriefing to feel helpful, including the being given the opportunity for reflection, gaining a shared experience, and having the right peer facilitator. Some evidence suggests that debriefing with staff working in clinical settings can reduce posttraumatic distress symptoms, and subjective evidence suggests that clinical staff members perceive debriefing to be useful. Due to the limited literature, no firm conclusions could be drawn, and further methodologically sound research is required.
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Affiliation(s)
- Zoe Scott
- Norwich Medical School, University of East Anglia, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
| | - Sara O'Curry
- Cambridge University Hospital NHS Foundation Trust, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Kiki Mastroyannopoulou
- Norwich Medical School, University of East Anglia, University of East Anglia, Norwich, NR4 7TJ, United Kingdom
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Abstract
A new drug is introduced to the market. It has been approved (after stringent scrutiny) by regulators, who require ever more convincing evidence for safety and efficacy. Aside from the increased costs of the new treatment compared with the old, what could the problems be?
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McIvor RJ, Canterbury R, Gunn J. Psychological care of staff following traumatic incidents at work. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.21.3.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Violence towards psychiatrists has been recognised as an occupational hazard for many years. With the development of community care it is increasingly likely to be encountered outside the hospital. To maximise personal safety in the community, psychiatrists need to be working in trusts in which an infrastructure to establish and maintain safety standards is in place.
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Lipinski K, Liu LL, Wong PWC. The effectiveness of psychosocial interventions implemented after the Indian Ocean Tsunami: A systematic review. Int J Soc Psychiatry 2016; 62:271-80. [PMID: 26809470 DOI: 10.1177/0020764015623807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Currently, the number of natural disasters has increased sixfold when compared to the 1960s. The 2004 Indian Ocean Tsunami offered provided an opportunity for scientifically investigating the effectiveness of post-disaster programs across countries with diverse ethnic, religious and cultural backgrounds. AIM This study aimed to assess the effectiveness of psychological interventions focused on the prevention or reduction in post-traumatic stress disorder (PTSD) symptoms and/or enhancement of psychological well-being implemented after the 2004 Tsunami. METHODS We systematically searched through MEDLINE, PsycINFO and The Published International Literature on Traumatic Stress (PILOTS) databases using the following keywords: 'tsunami' OR 'Indian Ocean', AND 'intervention'. RESULTS Our systematic review included 10 studies which adopted 10 different psychological interventions. A total of 8 of the 10 studies reported positive results in reducing PTSD symptoms and most interventions showed high levels of cultural sensitivity. No significant harmful effects of the included interventions were identified although two studies used potentially harmful interventions. CONCLUSION Evidence-based practice is a process of collaborative decision-making between the affected ones and interventionists. The practitioner assesses not only the availability of the level of evidence of the preferred interventions, but he or she also assesses his or her own expertise, the availability of resources, the surrounding context and the characteristics, values and preferences of relevant stakeholders.
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Affiliation(s)
- Kyle Lipinski
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Lucia L Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Paul W C Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
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Baxter JD, McCourt C, Jarrett PM. What is current practice in offering debriefing services to post partum women and what are the perceptions of women in accessing these services: a critical review of the literature. Midwifery 2013; 30:194-219. [PMID: 24491690 DOI: 10.1016/j.midw.2013.12.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/08/2013] [Accepted: 12/18/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE the main research question is to describe current practice in offering debriefing services to post partum women and learn about the perceptions of women accessing these services. DESIGN critical review of the literature using a meta ethnography approach. FINDINGS 20 papers were identified. These included four surveys, three qualitative studies, one mixed methods study and three literature reviews. Nine randomised controlled trials (RCTs) provided additional information from alongside surveys and description of interventions. Two types of debriefing were identified: structured and unstructured. The more formal psychoanalytic forms took place within the RCTs whilst the unstructured discussion sessions commonly with midwives were identified in other research papers. In addition there is confusion amongst service providers about the nature of debriefing and what is delivered. Various aspects of providing a postnatal debriefing service were identified including the optimal timing, specific groups offered debriefing and the number of sessions offered. Postnatal debriefing enabled women to have their birth experiences validated by talking and being listened to and being provided with information. Finally from the limited literature identified relating to midwives' perceptions of postnatal debriefing there was an overall feeling from midwives that they considered it to be beneficial to women. KEY CONCLUSIONS the findings of this literature review imply that women's responses to receiving postnatal debriefing are generally positive. This review has found that women appear to value talking and being listened to by a midwife following birth. They seem to have a strong need to have their story heard. This discussion also allows the women to have questions answered and information given where necessary. The whole process places a seal on a woman's birth experience which is validated. IMPLICATIONS FOR PRACTICE although there is no evidence to suggest that postnatal debriefing reduces morbidity, women find the service of value. Maternity providers should consider offering a postnatal debriefing service to meet those needs in advance of further research in this area.
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Affiliation(s)
- Jackie D Baxter
- Imperial Healthcare NHS Trust, Du Cane Road, Hammersmith, London W12 0HS, UK.
| | - Christine McCourt
- School of Health Sciences, City University London, Bartholomew Close, London EC1 7QN, UK.
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Efficiency of a four-item posttraumatic stress disorder screen in trauma patients. J Trauma Acute Care Surg 2013; 75:722-7. [DOI: 10.1097/ta.0b013e3182a53a5f] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bell DS, Champion JR. PTSD: another forensic epidemic of pseudo-illness. AUST J FORENSIC SCI 2013. [DOI: 10.1080/00450618.2012.713002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wu S, Zhu X, Zhang Y, Liang J, Liu X, Yang Y, Yang H, Miao D. A new psychological intervention: "512 Psychological Intervention Model" used for military rescuers in Wenchuan Earthquake in China. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1111-9. [PMID: 21789502 DOI: 10.1007/s00127-011-0416-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 07/09/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to compare the efficacy of the "512 Psychological Intervention Model" (that is, "512 PIM", a new psychological intervention) with debriefing on symptoms of post-traumatic stress disorder (PTSD), anxiety and depression of Chinese military rescuers in relation to a control group that had no intervention. METHOD We conducted a randomized controlled trial with 2,368 military rescuers 1 month after this event and then at follow-up 1, 2 and 4 months later to evaluate changes in symptoms of PTSD, anxiety and depression based on DSM-IV criteria, respectively. RESULTS Baseline analysis suggested no significant differences between the study groups. Severity of PTSD, anxiety and depression decreased over time in all three groups, with significant differences between the groups in symptoms of PTSD (P < 0.01). Compared with the debriefing and control group, significant lower scores of PTSD and positive efficacy in improving symptoms of re-experiencing, avoidance and hyperarousal were found in the "512 PIM" group. CONCLUSION "512 PIM" was an effective psychological intervention for military rescuers in reducing symptoms of PTSD, anxiety and depression after a crisis.
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Affiliation(s)
- Shengjun Wu
- Department of Psychology, School of Aerospace Medicine, Fourth Military Medical University, 169 West Changle Road, Xi'an, 710032, People's Republic of China
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Macnab A, Sun C, Lowe J. Randomized, Controlled Trial of Three Levels of Critical Incident Stress Intervention. Prehosp Disaster Med 2012; 18:367-71. [PMID: 15310050 DOI: 10.1017/s1049023x00001333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Stress debriefing following exposure to a critical incident isbecoming more prevalent. Its aim is to prevent or minimize the development of excessive stress response symptoms that lead to loss of productivity or effectiveness in the workplace or at home. There is little evidence that any form of psychological debriefing is effective. This study evaluated the effectiveness of three intervention strategies, and attempted to correlate the symptoms with the severity of the incidentand level of intervention.Methods:A randomized, controlled trial of three levels of critical stress intervention was conducted in the British Columbia Ambulance Service (BCAS), in British Columbia, Canada, among paramedics and emergency medical technicians (EMTs), reporting critical incident stress. Outcomes were measured at one week (Stanford Acute Stress Reaction Questionnaire (SASRQ), the Life Impact Score (LIS), and Schedule of Recent Events (SRE)), and at three months and six months following the intervention (Impact of Events (IE), Coping Mechanisms, LIS, and SRE).Results:Fifty calls were received during the 26-month study period (<1 per 10,000 BCAS response calls): 23 were by third parties, but the involved EMT did not call;nine were placed by crew unwilling to participate in the study; 18 subjects enrolled, but six completed no forms. No correlation was found between severity of the incident and scores on the SASRQ, IE, or LIS, or between any of these scores. There was no consistent pattern in the stress scores over time.Conclusion:Requests for critical incident stress intervention were uncommon. The need for intervention may not be as great as generally is assumed. Further randomized trials, ideally multicenter studies, are indicated.
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Affiliation(s)
- Andrew Macnab
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
AbstractTraumatic stress stems from a threat to an individual's or a group's very existence. The impact of the existential threat may be compounded by an inability to cope, which affects the perception of helplessness and loss of lawfulness. A model is proposed in which the traumatic process is conceptualized to develop through three stages: (1) alert; (2) impact; and (3) post-trauma. In this model, treatment of traumatic stress emphasizes the need to control and expand life, and to achieve lawfulness and meaningfulness. In the proposed model of treatment, there are essential differences at each of the stages of the traumatic process: (1) primary prevention at the stage of alert focuses on planning strategies for coping; (2) secondary prevention at the stage of impact is based on forward treatment and debriefing; and (3) tertiary treatment at the post-trauma stage attends to coping with internal chaos and arbitrariness.
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Critical Incident Stress Intervention After Loss of an Air Ambulance: Two-year Follow Up. Prehosp Disaster Med 2012. [DOI: 10.1017/s1049023x0002848x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Following an air ambulance crash with five fatalities, critical incident stress debriefing (CISD) was provided for involved paramedics, physicians, and nurses. A study was conducted to evaluate the long-term effects of a critical incident with critical incident stress debriefing according to the Mitchell model.Methods:Six months following the incident, empirically designed questionnaires were mailed to all transport paramedics and directly involved medical staff, and a random sample of both nurses from the dispatch/receiving institution and paramedics from around the province. Twenty-four months post-incident, all members of the transport paramedics completed the Impact of Events Scale and the General Health Questionnaires.Results:There were no differences between groups on any scores, except for disturbed sleep patterns, bad dreams, and the need for personal counseling being greater among transport paramedics at one day. There was no correlation between how well the deceased individuals were known, amount of debriefing, and symptom severity. A trend was seen for those with pre-existing stress management routines to have less severe symptoms at six months (p = 0.07). At two years, 16% of transport paramedics still had significant abnormal behavior.Conclusion:CISD did not appear to affect the severity of stress symptoms, whereas having pre-existing stress management strategies may. These findings give justification for proceeding to a randomized, controlled trial of different levels of critical incident stress intervention.
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Lopez G. Why verbal psychotherapy is not enough to treat Post Traumatic Stress Disorder: a Biosystemic approach to stress debriefing. BODY MOVEMENT AND DANCE IN PSYCHOTHERAPY 2011. [DOI: 10.1080/17432979.2011.583060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Harris MB, Baloğlu M, Stacks JR. MENTAL HEALTH OF TRAUMA-EXPOSED FIREFIGHTERS AND CRITICAL INCIDENT STRESS DEBRIEFING. JOURNAL OF LOSS & TRAUMA 2011. [DOI: 10.1080/10811440290057639] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chan AOM, Huak CY. Emotional impact of 2004 Asian tsunami on Singapore medical relief workers. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/15031430510034695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Healy D. Trussed in evidence? Ambiguities at the interface between clinical evidence and clinical practice. Transcult Psychiatry 2009; 46:16-37. [PMID: 19293278 DOI: 10.1177/1363461509102285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article considers the dominance that randomized controlled trials (RCTs) of psychotropic agents currently have in relation to the practice of psychiatry in mental health and primary care settings. In contemporary psychiatry, data of marginal significance based on rating scale measures are privileged as evidence that treatments are effective, while judgments of drug effects based on clinical practice are downgraded. The dominance of RCTs has also led to an increasing promotion of rating scales in clinical practice, described here as ;rating scale mongering.' The logical consequence of current interpretations of RCT data is that clinicians should adhere to guidelines which are based on a systematic assembly of such data, but the selective publication of trial data and ghostwriting of publications, lays the basis for guideline capture, and a corresponding capture of evidence-based clinical practice by pharmaceutical companies.
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Affiliation(s)
- David Healy
- Cardiff University, Department of Psychological Medicine, Hergest Unit, Ysbyty Gwynedd, Bangor, Wales, UK.
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Long-term psychosocial sequelae of stillbirth: phase II of a nested case-control cohort study. Arch Womens Ment Health 2009; 12:35-41. [PMID: 19137447 DOI: 10.1007/s00737-008-0040-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 12/05/2008] [Indexed: 10/21/2022]
Abstract
Stillbirth is associated with increased psychological morbidity in the subsequent pregnancy and puerperium. This study aimed to assess longer-term psychological and social outcomes of stillbirth and to identify factors associated with adverse outcome. We conducted seven-year follow-up of a cohort of women who were initially assessed during and after a pregnancy subsequent to stillbirth, together with pair-matched controls. All women were living with a partner at baseline and none had live children. Measured outcomes at follow-up included depression, posttraumatic stress disorder (PTSD) and partnership breakdown. Comparison variables included social and psychological factors and, for the stillbirth group, factors relating to the lost pregnancy. There were no differences between groups in case level psychological morbidity, but significantly higher levels of PTSD symptoms persisted in stillbirth group mothers who had case level PTSD 7 years earlier. Stillbirth group mothers were more likely to have experienced subsequent partnership breakdown. In the stillbirth group such breakdown was associated with having held the stillborn infant and having had case-level PTSD. Interpretations and clinical implications of these findings are discussed.
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Addis N, Stephens C. An Evaluation of a Police Debriefing Programme: Outcomes for Police Officers Five Years after a Police Shooting. ACTA ACUST UNITED AC 2008. [DOI: 10.1350/ijps.2008.10.4.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To evaluate the effectiveness of a debriefing programme to reduce traumatic stress in a police organisation, officers involved in a shooting were surveyed by questionnaire, five years after the event. The results showed that 79 per cent of 57 officers had not received debriefing, despite its mandatory status. Those who had received debriefing had higher post-traumatic stress disorder (PTSD) scores; however, regression of PTSD and health scores, on stress perceptions, social support, other trauma, and debriefing, showed that debriefing had no significant effect. These results support those of other controlled studies suggesting that debriefing does not mitigate PTSD and may exacerbate symptoms. A number of limitations of the present study are discussed in terms of suggestions for urgent evaluation of such programs in organisational settings.
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Affiliation(s)
- Nicola Addis
- School of Psychology, Massey University, Palmerston North, New Zealand
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Harrison J, Sharpley J, Greenberg N. The Management of Post Traumatic Stress Reactions in the Military. J ROY ARMY MED CORPS 2008; 154:110-4. [DOI: 10.1136/jramc-154-02-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Affiliation(s)
- Janice L Krupnick
- Department of Psychiatry, Georgetown University Medical School, Washington, DC, USA
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Gould M, Greenberg N, Hetherton J. Stigma and the military: evaluation of a PTSD psychoeducational program. J Trauma Stress 2007; 20:505-15. [PMID: 17721966 DOI: 10.1002/jts.20233] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Trauma risk management (TRiM) is an intensive posttraumatic stress disorder (PTSD) psychoeducational management strategy based on peer-group risk assessment developed by the UK Royal Navy (RN). TRiM seeks to modify attitudes about PTSD, stress, and help-seeking and trains military personnel to identify at-risk individuals and refer them for early intervention. This quasiexperimental study found that TRiM training significantly improved attitudes about PTSD, stress, and help-seeking from TRiM-trained personnel. There was a nonsignificant effect on attitudes to seeking help from normal military support networks and on general health. Within both the military and civilian populations, stigma is a serious issue preventing help-seeking and reducing quality of life. The results suggest that TRiM is a promising antistigma program within organizational settings.
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Affiliation(s)
- Matthew Gould
- Department of Clinical Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK
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Abstract
This paper is based on the Bruce Burns Memorial Trust Lecture, Terrorism and Mental Health, presented in October 2005, in Birmingham. In addition to written sources, it is informed by the author's experience and contact with military and police experts in this arena over 28 years as a member of the British Army. The diagnosis and treatment of post traumatic mental disorders are not addressed in this paper. The author explores the general phenomenon of terrorism, in an endeavour to inform understanding of terrorist acts. He stresses the need for contextualisation of acts of terror, their perpetrators, their effects on populations and individuals, and attention to the psychology of groups. The author aims to invite and inform further thought and debate on the subject by raising a wide range of issues which do not sit comfortably within a strict psychiatric, research-based paradigm. The author covers a brief history of terrorism; organisational requirements of terror groups and the process of recruiting personnel to them; the means, motives and opportunities terrorists exploit in their work; the need for communication with terror groups; sacrificial death; governmental responses to terrorist acts and fear and mental health. The author proposes that terrorist organisations perform some of the functions of a family; that acts of terror are 'propaganda by deed'; that terrorism, or more precisely the media's treatment of it, breeds 'formless fears' which may directly lead to the development of fear-based symptoms and illness within societies. He notes that terrorism is an enterprise from which many players ('experts', media, politicians, etc.) benefit; that terrorism has its shadow in counter-terrorism, which may range from benign to malignant and that psychiatry could, in this context, acknowledge its bias towards individual psychologies and rectify its lack of understanding of groups and the behaviours of individuals within them.
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Affiliation(s)
- Ian Palmer
- Veterans' Policy Unit, Baird Medical Centre, Gassiot House, St Thomas' Hospital, London.
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Rowan C, Bick D, Bastos MHDS. Postnatal Debriefing Interventions to Prevent Maternal Mental Health Problems After Birth: Exploring the Gap Between the Evidence and UK Policy and Practice. Worldviews Evid Based Nurs 2007; 4:97-105. [PMID: 17553110 DOI: 10.1111/j.1741-6787.2007.00088.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postnatal mental health problems range from transient psychological problems to depression, anxiety, psychosis, and post-traumatic stress disorder (PTSD). Debriefing is a structured psychological intervention to prevent postnatal psychological problems, particularly PTSD and depression. Many UK maternity service providers have established postnatal debriefing services, in some cases supported by policy, despite a lack of robust evidence. In this article, current evidence of the effectiveness of postnatal debriefing and the availability and current provision of debriefing offered in UK maternity services is described. METHODS A structured literature review was undertaken. FINDINGS Eight randomized controlled trials were conducted to evaluate debriefing or counseling interventions in childbirth settings, and seven studies were done to evaluate debriefing or counseling interventions provided within UK maternity services or describe the availability of such services. Results of six RCTs were that no differences in outcomes were found, one report indicated possible harm from debriefing, and two indicated a positive association related to a psychological intervention. Methodological issues might account for differing trial outcomes. No standard intervention was used in any RCTs or service interventions. Confusion apparently exists in use of the term "debriefing" in UK maternity service policy and practice. Although service evaluations showed that women valued opportunities to discuss their birth, evidence to support the content and timing of service provision and effectiveness of this was lacking. DISCUSSION It might be appropriate to consider offering women an opportunity to discuss their childbirth experience and to differentiate this discussion from the offer of a formal debriefing, which is unsupported by evidence. IMPLICATIONS FOR PRACTICE/CONCLUSION: Midwives and other health care professionals who provide opportunities for women to talk about childbirth should be clear about terms used to describe the intervention, as well as the purpose and content of this. Differentiating between women who perceive their experience of childbirth as traumatic and those who develop symptoms of PTSD (for whom specific treatment may be required) is important. All health care professionals should be aware of the signs and symptoms of mental health problems after birth, which may include depression, anxiety, or psychosis in addition to PTSD.
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Affiliation(s)
- Cathy Rowan
- Centre for Research in Midwifery and Childbirth, Thames Valley University, London, UK.
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Tuckey MR. Issues in the debriefing debate for the emergency services: Moving research outcomes forward. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1468-2850.2007.00069.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McHugh PR, Treisman G. PTSD: a problematic diagnostic category. J Anxiety Disord 2007; 21:211-22. [PMID: 17085011 DOI: 10.1016/j.janxdis.2006.09.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 09/02/2006] [Accepted: 09/02/2006] [Indexed: 11/19/2022]
Abstract
Since the publication of Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, posttraumatic stress disorder (PTSD) has become a remarkably dominant theme in mental health discourse and diagnostic practice. This development has been encouraged by the diagnosis being officially presumed to exist in acute, chronic, delayed, complex, subdromal, and even "masked" forms. Here, we present an historical and clinical review that indicates how, since 1980, the term PTSD (along with its dubious embellishments) replaced established views on mental responses to trauma to the detriment of patient care and psychiatric investigation. From this historical perspective, we review and evaluate the natural course of emotional and behavioral reactions to traumatic experiences, and as well their assessment, formulation, and therapeutic management in both civilian and military situations. From this we conclude that the concept of PTSD has moved the mental health field away from, rather than towards a better understanding of the natural psychological responses to trauma. A return to prior standards of diagnostic practice and therapeutic planning would greatly benefit patient care, rehabilitative services to veterans, and epidemiologic research.
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Affiliation(s)
- Paul R McHugh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Kenardy J, Piercy JA. Effect of information provision on trauma symptoms following therapeutic writing. AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050060600726304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Justin Kenardy
- School of Psychology University of Queensland
- Centre of National Research on Disability and Rehabilitation Medicine, Mayne School of Medicine, University of Queensland , Herston, Queensland, Australia
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Abstract
This article reports on the findings of a qualitative study exploring the impact of SARS on social work practice in five different hospitals in Singapore. The study sought to examine the range of interventions adopted by 28 medical social workers and the theoretical orientations underpinning them. The findings discussed include the impact of infection control practices on social work intervention, the range of interventions undertaken, respondents' reflections and self-awareness, the role of values and ethics, creativity and training, and their recommendations for future emergencies. While the findings of the study relate specifically to hospital social work practice, the crisis and trauma nature of the work makes it applicable to a broader range of practice in these areas and a range of populations. The findings from this study could also inform the development of training programs for social work and other clinical health workers, and emergency management planning.
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Affiliation(s)
- Allison Rowlands
- Department of Social Work, Faculty of Arts and Social Sciences, University of Singapore, Singapore.
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Abstract
Dissemination of effective early interventions following trauma is necessary to ensure the provision of the best possible care in a timely manner. To achieve this, agreement from all key stakeholders is required regarding the messages to be disseminated and the means of dissemination. This article is based on a National Institute of Mental Health sponsored symposium on the dissemination of early interventions at the 21st annual meeting of the International Society for Traumatic Stress Studies in Toronto in 2005. The current knowledge base regarding the effectiveness and dissemination of early interventions (defined here as those that are begun within the first 3 months after exposure) following trauma for children, adolescents, and adults is considered.
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Affiliation(s)
- Jonathan I Bisson
- Department of Psychological Medicine, University Hospital of Wales, Cardiff University, Cardiff, United Kingdom.
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Sijbrandij M, Olff M, Reitsma JB, Carlier IVE, Gersons BPR. Emotional or educational debriefing after psychological trauma. Randomised controlled trial. Br J Psychiatry 2006; 189:150-5. [PMID: 16880485 DOI: 10.1192/bjp.bp.105.021121] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent studies show that individual single-session psychological debriefing does not prevent and can even aggravate symptoms of post-traumatic stress disorder (PTSD). AIMS We studied the effect of emotional ventilation debriefing and educational debriefing v. no debriefing on symptoms of PTSD, anxiety and depression. METHOD We randomised 236 adult survivors of a recent traumatic event to either emotional ventilation debriefing, educational debriefing or no debriefing (control) and followed up at 2 weeks, 6 weeks and 6 months. RESULTS Psychiatric symptoms decreased in all three groups over time, without significant differences between the groups in symptoms of PTSD (P=0.33). Participants in the emotional debriefing group with high baseline hyperarousal score had significantly more PTSD symptoms at 6 weeks than control participants (P=0.005). CONCLUSIONS Our study did not provide evidence for the usefulness of individual psychological debriefing in reducing symptoms of PTSD, anxiety and depression after psychological trauma.
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Affiliation(s)
- Marit Sijbrandij
- Academic Medical Centre, Department of Psychiatry, Tafelbergweg 25, 1105 BC, Amsterdam, The Netherlands.
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Lehna C, Sheaffer J, Andrade-Pulido M, Martinez A, Bishop B. Using nurse shadowing as the focus for a recruitment program. J Pediatr Nurs 2006; 21:73-9. [PMID: 16428017 DOI: 10.1016/j.pedn.2005.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The nurse recruitment program at our private children's hospital provides an opportunity for family members of employees who are interested in becoming a nurse to learn more about pediatric nursing. This article describes our 5-hour recruitment program that includes didactic information, a hospital tour, and clinical experience through "nurse shadowing." Participants, presenters, and nurse preceptors have favorably evaluated this program. Programs like this can be used by other institutions to encourage and maintain interest in nursing and the health care professions.
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Affiliation(s)
- Carlee Lehna
- Shriners Hospital for Children-Galveston, Galveston, TX 77550, USA.
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Stallard P, Velleman R, Salter E, Howse I, Yule W, Taylor G. A randomised controlled trial to determine the effectiveness of an early psychological intervention with children involved in road traffic accidents. J Child Psychol Psychiatry 2006; 47:127-34. [PMID: 16423143 DOI: 10.1111/j.1469-7610.2005.01459.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether an early intervention using a psychological debriefing format is effective in preventing psychological distress in child road traffic accident survivors. DESIGN Randomised controlled trial. SETTING Accident and Emergency Department, Royal United Hospital, Bath. SUBJECTS 158 children aged 7-18. Follow-up assessment completed eight months post accident with 132 (70/82 of the experimental group and 62/76 in the control group). MAIN OUTCOME MEASURES Self-completed measures of psychological distress; fulfilment of diagnostic criteria for post-traumatic stress disorder. RESULTS Children in both groups demonstrated considerable improvements at follow-up. The early intervention did not result in any additional significant gains. CONCLUSIONS Although children in this study made significant improvements it is unclear whether these are better or worse than natural recovery rates. The specific intervention did not result in additional gains although the structured assessment provided for both groups may have been helpful in reducing subsequent pathology.
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Affiliation(s)
- Paul Stallard
- Avon and Wiltshire Mental Health Partnership NHS Trust/University of Bath, UK.
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Sin SS, Huak CY. Psychological impact of the SARS outbreak on a Singaporean rehabilitation department. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2004. [DOI: 10.12968/ijtr.2004.11.9.19589] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sim So Sin
- Rehabilitative Services, Changi General Hospital, Singapore 529889 and
| | - Chan Yiong Huak
- Unit, Faculty of Medicine, National University of Singapore, Singapore
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Bär O, Pahlke C, Dahm P, Weiss U, Heuft G. [Secondary prevention for police officers involved in job-related psychologically stressful or traumatic situations]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2004; 50:190-202. [PMID: 15146394 DOI: 10.13109/zptm.2004.50.2.190] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Police officers are at high risk of being exposed to psychologically straining situations and potentially psychotraumatic experiences. In this article, such situations are exemplified and categorized, and the role and significance of secondary prevention following traumatic experiences is discussed. METHODS From 1994 to 2003, 649 police officers received secondary prevention after being involved in a total of 250 potentially traumatic or psychologically stressful incidents. Psychological support was provided by teams of specially trained professionals in the acute phase after the incident following careful psychological evaluation. In a retrospective evaluation, the diagnoses obtained were analyzed with regard to sex and age and correlated with the severity of the incident. Three clusters of potentially traumatic situations were formed: (1) Employment of fire-arms with danger for the officer, (2) Standard situations including violence towards a third party, (3) Suicide or attempted suicide of a police officer. RESULTS Police officers who experienced events assigned to cluster (1), comprising situations with considerable traumatic potential, had the highest incidence of posttraumatic stress disorder (PTSD) or other mental illness. Compared to male officers, females were more often diagnosed with other mental illness, whereas males had a higher incidence of PTSD. Cluster (2), which comprised situations of an officer's daily professional life, was not associated with an increased risk of mental illness. Officers were apparently capable of coping with situations considered psychologically straining for the general public without detectable evidence of a traumatic reaction. In cluster (3), which reflects the most dramatic interference with team relations, other forms of mental illness were diagnosed at a higher incidence.
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Affiliation(s)
- Olaf Bär
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Münster, Muenster, Germany.
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Aulagnier M, Verger P, Rouillon F. [Efficiency of psychological debriefing in preventing post-traumatic stress disorders]. Rev Epidemiol Sante Publique 2004; 52:67-79. [PMID: 15107694 DOI: 10.1016/s0398-7620(04)99023-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Traumatic events are frequently followed by an acute stress reaction that may develop into a post-traumatic stress disorder. An intervention called psychological debriefing has been proposed to prevent these disorders. Although this method is widely used at present, its preventive effect is controversial. This article consist in a review of the studies which evaluated psychological debriefing efficiency in the prevention of post-traumatic stress disorder and associated disorders in adults. METHOD We carried out a bibliographical search on MEDLINE (1966-2001), PASCAL (1987-2001), EMBASE (1988-2001), FRANCIS (1984-2001) and SCIENCEDIRECT (1967-2001). The key words were posttraumatic stress disorder, debriefing, treatment, psychological follow up, and prevention. We selected the studies with the following criteria: adults, one psychological debriefing session in the Month following the event, inclusion of a control group, more than 20 persons per group and evaluation of psychological disorders with standardized instruments more than one Month after the trauma. RESULTS Twenty nine studies were identified and 8 selected. Four studies did not show any intervention effect, 3 suggested a negative intervention effect, and 1 suggested a positive effect on anxiety, depressive symptoms and alcohol dependence. CONCLUSION Psychological debriefing implies re-exposure through memory processes to the trauma, which can interfere with the natural course of adjustment and recovery. Several Authors have suggested that psychological debriefing may delay the diagnosis and thus the early treatment of post-traumatic stress disorder. Psychological debriefing may not be appropriate to all victims of every type of incident or trauma. We discuss the intervention and its design. This review did not show evidence for psychological debriefing efficiency, as a unique session, in the prevention of posttraumatic reactions. The design and the objectives may be re-examined. Further evaluations following rigorous methods are warranted.
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Affiliation(s)
- M Aulagnier
- Observatoire Régional de la Santé de Provence-Alpes-Côte d'Azur (ORS - PACA), 23, rue Stanislas-Torrents, 13006 Marseille.
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Robertson M, Humphreys L, Ray R. Psychological treatments for posttraumatic stress disorder: recommendations for the clinician based on a review of the literature. J Psychiatr Pract 2004; 10:106-18. [PMID: 15330406 DOI: 10.1097/00131746-200403000-00005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reviews available research data supporting the use of psychotherapy in the treatment of posttraumatic stress disorder (PTSD). The authors highlight how this evidence might inform clinical choices in treating PTSD, as well as demonstrating how assumptions based on gaps in the available literature may be misleading. The authors first discuss findings concerning a number of interventions that are commonly used in the treatment of trauma victims or patients with PTSD: critical incident stress debriefing, psychoeducation, exposure therapy, eye movement desensitization reprocessing, stress inoculation therapy, trauma management therapy, cognitive therapy, psychodynamic psychotherapy, and hypnotherapy. They also discuss a number of treatment strategies that have recently been studied in PTSD, including imagery rehearsal, memory structure intervention, interpersonal psychotherapy, and dialectical behavior therapy. PTSD is associated with significant symptomatic morbidity, although desired outcomes in clinical practice are typically related more to reduction in social, interpersonal, and occupational impairment. The most methodologically robust studies, which have typically examined cognitive or behavioral treatments, indicate that psychotherapy helps to relieve symptom severity; however, there is no consistent information about whether these interventions are helpful in improving other domains of impairment and associated disability, even though these problems are often the greatest concern to patients. Nor does the available evidence indicate when, and for whom, various psychotherapeutic interventions should be provided, or whether different modalities of treatment can and should be combined, or sequentially offered, as is often done in specialized treatment programs. Clinicians should keep these issues in mind in reviewing the literature on current (and future) clinical research. Unfortunately, the current evidence base on psychotherapy for PTSD gives only limited guidance concerning clinical choices in managing PTSD. The authors therefore provide some clinical guidelines based on the literature for clinicians treating patients with PTSD.
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40
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Bisson JI, Kitchiner NJ. Early Psychosocial and Pharmacological Interventions After Traumatic Events. J Psychosoc Nurs Ment Health Serv 2003; 41:42-51. [PMID: 14571632 DOI: 10.3928/0279-3695-20031001-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. There is no evidence to suggest that routine provision of single-session psychological interventions after traumatic events prevents the development of psychological sequelae. Some such evidence exists regarding multiple-session, cognitive-behavioral interventions. 2. There is no evidence to suggest that routine use of pharmacological agents prevents development of psychological sequelae in traumatized individuals. 3. Given the current evidence base, development of stepped-care programs focusing on education, screening, and treatment is warranted. 4. Currently, the main role of mental health professionals early on is to ensure emotionally supportive systems of care are in place, which will help identify individuals who appear most distressed so evidence-based interventions can be offered.
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Affiliation(s)
- Jonathan I Bisson
- University Hospital of Wales, Heath Park, Cardiff, United Kingdom CF14 4XN.
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41
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Promotion of emotional disclosure following illness and injury: A brief intervention for medical patients and their families. COGNITIVE AND BEHAVIORAL PRACTICE 2003. [DOI: 10.1016/s1077-7229(03)80053-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Griffiths R, Emrys E, Finney Lamb C, Eagar S, Smith M. Operation Safe Haven: the needs of nurses caring for refugees. Int J Nurs Pract 2003; 9:183-90. [PMID: 12801250 DOI: 10.1046/j.1440-172x.2003.00422.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nurses played a significant role in providing care to Kosovar and East Timorese refugees at the East Hills Reception Centre in Sydney, Australia, during Operation Safe Haven in 1999-2000. To ascertain the needs of nurses in this setting, 13 nurses participated in two focus group interviews, and two in-depth interviews were conducted with nursing managers. Qualitative thematic analysis was conducted on the resulting transcripts. Nurses reported that, overall, they had the necessary clinical skills but needed specific refugee health profiles and training in culturally competent and trauma-sensitive care. The nurses experienced trauma-related, cultural, environmental and role-related stressors. They used a variety of informal psychosocial supports but reported the need for ongoing counselling and debriefing. While clinical skills were considered important, nurses identified other factors as having more impact on their ability to provide comprehensive care for traumatized refugees, particularly their role as client advocates.
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43
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Sabin-Farrell R, Turpin G. Vicarious traumatization: implications for the mental health of health workers? Clin Psychol Rev 2003; 23:449-80. [PMID: 12729680 DOI: 10.1016/s0272-7358(03)00030-8] [Citation(s) in RCA: 215] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It has been suggested that a unique feature of some mental heath practitioners' work is exposure through their role as therapists to clients' descriptions of and reactions to trauma, and that these experiences may actually indirectly cause distress and traumatization to the therapist. This proposed phenomenon has been termed "vicarious traumatization" (VT) and is the focus of the current review. The concept of VT, together with other related concepts such as "burnout," "compassion fatigue," "secondary traumatic stress" (STS), and "work stress" are appraised. Psychological mechanisms that might be theoretically involved in VT are considered. The measurement of VT is reviewed alongside the limited research evidence supporting its existence. Factors such as direct trauma exposure and the personal attributes of mental health workers, which have been suggested to be associated with VT, are also assessed. It is concluded that the evidence to support the existence of VT is meager and inconsistent. Future research needs to be directed at distinguishing VT from other sources of distress arising within the workplace. Finally, the organizational relevance of VT and its possible implications for the management of mental health workers are critically appraised.
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Affiliation(s)
- Rachel Sabin-Farrell
- Department of Clinical Psychology, Nottinghamshire Healthcare National Health Service Trust, Southwell Road, Nottinghamshire, Mansfield NG18 4HH, UK.
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44
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Abstract
Single-session early psychological interventions became widely advocated during the 1980s and 1990s as a way to prevent the development of psychological sequalae following traumatic events. There have now been 13 randomised controlled trials of single-session interventions within 1 month of a traumatic event. Notwithstanding their methodological shortcomings and clinical heterogeneity, the results are neutral overall in terms of clinical effectiveness. Possible explanations include a failure to encourage individuals' personal coping mechanisms and defence mechanisms and that insufficient time was allowed for habituation to intense exposure to occur. With the present evidence, the routine use of single-session interventions following traumatic events cannot be justified. This does not mean that there should be nothing offered, as many individuals involved in traumatic events clearly have emotional needs. Hopefully, future research will identify alternative forms of early intervention that prove useful to those individuals who would otherwise develop more significant psychological difficulties.
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Affiliation(s)
- Jonathan I Bisson
- Department of Liaison Psychiatry, University Hospital of Wales, Monmouth House, Heath Park, Cardiff, CF14 4XW, UK.
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46
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Abstract
AIMS OF THE STUDY To determine: (1) the types of clinical events nurses perceived as 'critical'; and (2) whether nurses' experiences of critical incidents were associated with any demographic variables such as qualifications and current area of work. BACKGROUND A review of the literature revealed little research has investigated in detail which clinical events nurses perceived as 'critical', apart from two North American studies. Exploratory research of Australian nurses was undertaken to confirm and contrast their understandings and views with those of other work specialties and North American findings. DESIGN/METHODS Two hundred and twenty-seven full-time registered nurses at a metropolitan medical centre responded to a survey questionnaire designed for the study based on findings of earlier studies regarding critical incidents. RESULTS Respondents viewed the sexual abuse of a child and death of a child as the most critical of events listed on the questionnaire and an emergency situation as the most frequent and stressful incident in the previous year. Factor analysis indicated the existence of three types of critical incident represented by Grief, Emergency, and Risk Scales. Events on the Grief scale were most stressful for respondents. Although several significant relationships were found for demographics with the Grief and Risk Scales, findings were considered tentative because of disproportionate representation on many of the demographics. CONCLUSION Further research is necessary to substantiate the findings of the study. However, the identification of the scales provided a concise way of conceptualizing the essential elements of critical incidents.
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Affiliation(s)
- Jillian O'Connor
- Aged Psychiatry, Caulfield General Medical Centre, Caulfield, Victoria, Australia
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47
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Jones L. Adolescent understandings of political violence and psychological well-being: a qualitative study from Bosnia Herzegovina. Soc Sci Med 2002; 55:1351-71. [PMID: 12231014 DOI: 10.1016/s0277-9536(01)00275-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Harvard Trauma Questionnaire and Hopkins Symptoms Checklist (HSCL-25) were given to 337 13-15 year olds who had lived through the recent war in Bosnia Herzegovina, on opposite sides of the conflict. A gender-balanced sub-sample of 40 adolescents was selected on the basis of their combined symptom scores, including equal numbers of high and low scorers from each side. A year of participant observation in two cities and in-depth interviews were conducted with the sub-sample to explore their understandings of the war and their subjective perceptions of their psychological well-being. Case studies are presented to show that the degree to which an adolescent engaged in a search for meaning to the conflict is related to their psychological well-being. Searching for meaning did not appear to be protective. Less well adolescents in both cities were more engaged in searching for meaning. Well adolescents appeared to be more disengaged. Searching for meaning appeared to be associated with sensitivity to the political environment, and feelings of insecurity about the prospect of a future war. The particular local context had an important effect in mediating the manner in which disengagement and engagement occurred. These findings suggest that the more avoidant methods of coping with political violence warrant further investigation. Political engagement may be protective in low-level conflicts where there is a possibility for action. When there is little opportunity for active engagement, the search for meaning has a different effect. Adolescents engaged in the search for meaning recognise that their recovery is bound up with the recovery of their communities as a whole. Assistance and support may have to address the material, social and political difficulties that the search uncovers.
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Affiliation(s)
- Lynne Jones
- Centre For Family Research, Social and Political Sciences Faculty, Cambridge University, Free School Lane, Cambridge CB2 3RF, UK.
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Pedersen D. Political violence, ethnic conflict, and contemporary wars: broad implications for health and social well-being. Soc Sci Med 2002; 55:175-90. [PMID: 12144134 DOI: 10.1016/s0277-9536(01)00261-1] [Citation(s) in RCA: 213] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ethnic conflict, political violence and wars that presently shape many parts of world have deep-seated structural causes. In poor and highly indebted countries, economic and environmental decline, asset depletion, and erosion of the subsistence base lead to further impoverishment and food insecurity for vast sectors of the population. Growing ethnic and religious tensions over a shrinking resource base often escort the emergence of predatory practices, rivalry, political violence, and internal wars. The nature of armed conflict has changed substantially over time and most strategic analysts agree that in the second half of the 20th century, contemporary wars are less of a problem of relations between states than a problem within states. Despite the growing number of armed conflicts and wars throughout the world, not enough attention has been paid to the local patterns of distress being experienced and the long-term health impact and psychosocial consequences of the various forms of political violence against individuals, communities, or specific ethnic groups. The short or long-term impact assessment on civilian populations of poor countries affected by war have been scarce, and studies focussing on experiences of collective suffering and trauma-related disorders among survivors are beginning to emerge in the scientific literature. The medicalization of collective suffering and trauma reflects a poor understanding of the relationships among critically important social determinants and the range of possible health outcomes of political violence.
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Affiliation(s)
- Duncan Pedersen
- Douglas Hospital Research Centre, McGill University, Montreal, Que., Canada.
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Hyams KC, Murphy FM, Wessely S. Responding to chemical, biological, or nuclear terrorism: the indirect and long-term health effects may present the greatest challenge. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2002; 27:273-291. [PMID: 12043900 DOI: 10.1215/03616878-27-2-273] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The possibility of terrorists employing chemical, biological, or nuclear/ radiological (CBN) materials has been a concern since 1995 when sarin gas was dispersed in a Tokyo subway. Contingency planning almost exclusively involved detection. containment, and emergency health care for mass casualties. However, it is clear that even small-scale CBN incidents--like the recent spread of anthrax spores through the mail--can cause widespread confusion, fear, and psychological stress that have lasting effects on the health of affected communities and on a nation's sense of well-being. More emphasis therefore needs to be placed on indirect effects and on the medical, social, economic, and legal consequences that follow months to years afterward. To respond effectively to CBN attacks, a comprehensive strategy needs to be developed that includes not only emergency response, but also long-term health care, risk communication, research, and economic assistance. Organizing an effective response challenges government institutions because the issues involved--eligibility for health care, the effects of low-level exposure to toxic agents. stress-related illnesses, unlicensed therapeutics. financial compensation--are complex and controversial.
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Gamble JA, Creedy DK, Webster J, Moyle W. A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress. Midwifery 2002; 18:72-9. [PMID: 11945055 DOI: 10.1054/midw.2001.0287] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND childbirth generates powerful emotions and may lead to the development of symptoms of depression, anxiety, and trauma in some women. Debriefing and non-directive counselling have been used as early interventions to reduce the prevalence of depression and post-traumatic stress. METHODS a review of the literature was conducted to describe the current state of knowledge on the effectiveness of a single debriefing session or non-directive counselling session to reduce depression and trauma symptoms in women following birth. FINDINGS a total of three studies reported in four papers examined the use of debriefing or non-directive counselling to prevent or reduce psychological morbidity following birth. The two largest RCTs indicate that a single debriefing session with the woman whilst in the postnatal ward is of no statistically significant value in reducing psychological morbidity and may even be harmful. In contrast, women reported that an opportunity to talk with someone about the birth was helpful in facilitating recovery. CONCLUSION there is insufficient evidence to draw conclusions about the effectiveness of debriefing following childbirth, primarily because it is unclear if a standardised debriefing intervention was used. Future research should clearly describe the intervention and test alternative interventions; measure a broader range of outcomes including trauma symptoms; use inclusion criteria that acknowledge the complex contributing factors to depression and trauma; and examine the value of including the woman's partner (or significant other) in the debriefing or counselling session(s). Future studies should investigate the timing or place of the intervention, the provision of more than one opportunity to discuss the birth, and target the intervention to women who are more likely to develop trauma symptoms or post-traumatic stress disorder.
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Affiliation(s)
- Jenny A Gamble
- School of Nursing, Faculty of Nursing and Health, Griffith University, Nathan Campus, Kessels Road, Brisbane, Queensland 4111, Australia.
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